Quality Metrics & Outcome Assessment Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Metrics & Outcome Assessment flashcards as text
A health plan wants to compare its MTM program performance to national benchmarks. The MOST appropriate benchmarking source for Part D star measures is:
Answer: CMS Part D Star Ratings Technical Notes and national percentile distributions
CMS publishes annual Part D Star Ratings Technical Notes with national cut points and percentile distributions used for plan-to-plan benchmarking.
The ECHO model of pharmacy outcomes organizes outcomes into three domains. These are:
Answer: Economic, Clinical, Humanistic
The ECHO model (Kozma et al., 1993) classifies pharmacy outcomes as Economic, Clinical, and Humanistic to provide a comprehensive evaluation framework.
A pharmacist calculates a cost-effectiveness ratio for an MTM intervention as $12,000 per QALY gained. This figure is interpreted as:
Answer: The incremental cost to gain one quality-adjusted life year compared to usual care
An incremental cost-effectiveness ratio (ICER) expresses the additional cost required to gain one QALY relative to the comparator intervention.
Under the CMS MTM program requirements, the minimum annual CMR completion rate that plans must target for eligible beneficiaries is:
Answer: 75%
CMS requires Part D sponsors to offer CMRs to all eligible MTM beneficiaries and has set a 75% completion rate target in the Star Ratings framework.
Which of the following correctly describes the difference between 'efficacy' and 'effectiveness' in MTM outcome assessment?
Answer: Efficacy is measured in controlled trials; effectiveness is measured in real-world practice
Efficacy reflects performance under ideal, controlled conditions (clinical trials), while effectiveness reflects performance in real-world clinical practice.
A quality improvement team uses a Pareto chart to prioritize MTM intervention targets. The Pareto principle suggests they should focus on the problems that:
Answer: Account for roughly 80% of outcomes while representing 20% of problem categories
The Pareto principle (80/20 rule) guides teams to focus on the vital few problem categories that produce the majority of negative outcomes.
A pharmacist documents a 'therapeutic duplication' drug therapy problem for a patient taking both naproxen and ibuprofen. In quality metric reporting, resolving this DTP would MOST directly improve which measure?
Answer: Drug therapy problem resolution rate and potentially NSAID overuse metrics
Resolving a therapeutic duplication DTP improves DTP resolution rates and, for NSAIDs in elderly patients, may also improve high-risk medication metrics.